Spontaneous coronary artery dissection: contemporary aspects of diagnosis and patient management

Abstract

Spontaneous coronary artery dissection is an increasingly recognised cause of acute coronary syndromes, especially in young and middle-age women. Recognising its particularities and differences with atherosclerotic disease is central for appropriately identifying and approaching these patients. The authors review the current state of knowledge on spontaneous coronary artery dissection and provide practical recommendations for the diagnosis and management of this condition, both in the acute and convalescence phases.

Keywords: coronary angiography; coronary artery disease; interventional cardiology; peripheral vascular disease.

Figure 1

Multimodal angiography of typical fibromuscular dysplasia pattern. Typical radiographic appearance of fibromuscular dysplasia as beading of the renal (panels 1, 2, 3) and carotid (panels 4, 5) arteries, detected with invasive angiography (1. 4), CT (2) and magnetic resonance (3, 5).

Figure 2

Angiographic presentations of spontaneous coronary artery dissection and corresponding anatomopathological features. First row describes the anatomical lesions behind each angiographic lesion (circles). Column 1 corresponds to angiotype 1: double lumen or luminal flap. Column 2 corresponds to angiotype 2: long smooth tapering. Column 3 corresponds to angiotype 3: focal stenosis.

Figure 3

Flowchart diagram for the diagnosis of spontaneous coronary artery dissection (SCAD). CVRF, cardiovascular risk factor; ICI, intracoronary imaging.

Figure 4

Spontaneous coronary artery dissection (SCAD) hallmarks in intracoronary imaging. FL, false lumen; IMH, intramural haematoma; TL, true lumen. Arrow indicates myoendothelial lamina (intimomedial flap).

Figure 5

Flowchart diagram for acute management of SCAD. CABG, coronary artery bypass graft surgery; PCI. percutaneous coronary intervention; SCAD, spontaneous coronary artery dissection; TIMI, thrombolysis in myocardial infarction.